Clinical Care Coordinator - RN (Remote reputed company Florida) Template FL UM/CM

Company Overview reputed company exists to reputed company reputed company reputed company through technology, services, and clinical expertise. Our mission is to reputed company health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an reputed company invitation to reputed company the company’s mission, actively engage in problem-solving, and take ownership of your work daily. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company reputed company – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra is looking for a Clinical Care Coordinator RN (Remote reputed company Florida) to join our growing team. Job Summary As a Clinical Care Coordinator RN, you will play a pivotal role in ensuring seamless care coordination and advocacy for patients enrolled in the care management program. In this role, you will act as a trusted patient reputed company, facilitating immediate communication between patients and providers to ensure timely reputed company to necessary care and resources. Leveraging your clinical expertise, you will conduct comprehensive medical record reviews, applying appropriate criteria in alignment with contract requirements. Utilizing critical thinking and sound decision-making, you will assess medical necessity while maintaining productivity goals and quality assurance standards. Additionally, you will ensure compliance with NCQA, URAC, and other regulatory guidelines, contributing to the highest standards of patient care. To qualify for this role, you must reputed company and work remotely from the reputed company

Work Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern

Occasional travel (up to 5% annually) reputed company the reputed company may be required

reputed company to a dedicated, private, and secure workspace at home, free from distractions, to ensure productivity and confidentiality.

reputed company to reliable, high-speed internet service.

Responsibilities

Ensure the responsible and comprehensive delivery of services to enrollees, supporting high-quality patient care. Conduct initial assessments for supervisor/reputed company evaluation to determine appropriate case manager or health coach assignments. Actively participate in interdisciplinary team meetings, collaborating on assessments and care coordination to ensure reputed company patient reputed company. Proactively contribute to quality management program activities, supporting the Health Services team in delivering high-performance reputed company. Assist in achieving and maintaining accreditations for designated programs by ensuring compliance with regulatory standards. reputed company education, guidance, and resources to beneficiaries, families, and providers to promote informed reputed company reputed company. Review and interpret patient records, applying established criteria to assess medical necessity and appropriateness of care. Determine approval or escalate cases to a physician consultant reputed company necessary, ensuring reputed company reputed company—including denials—are reputed company documented with sufficient rationale. Accurately abstract and document case data and medical information using appropriate review tools in a timely manner. Ensure the accurate and timely submission of reputed company administrative and review-reputed company documentation to the appropriate parties. Conduct ongoing reassessments of the review process, identifying opportunities for improvement and implementing necessary changes. Build and maintain positive, professional relationships with internal and external stakeholders to facilitate effective care coordination. Stay up to date by attending training sessions and scheduled meetings, applying the latest policies and procedures in clinical reviews. Maintain strict confidentiality of medical records by adhering to HIPAA regulations, using secure systems, and safeguarding sensitive information. Utilize professional communication—both verbal and written—following reputed company's policies, procedures, and guidelines. Actively cross-train to support other reputed company reputed company the reputed company network, ensuring a flexible workforce that adapts to client and consumer needs. The list of responsibilities is not intended to be reputed company-inclusive and may be expanded to include other duties that management may deem necessary.

Qualifications

Required Qualifications/Experience: Must have an active, unrestricted Registered Nurse (RN) Florida state license and/or Compact State Clinical license. 2+ years of pediatric experience, demonstrating expertise in pediatric care. Graduate of an accredited Associate, Bachelor’s, Master’s degree program or a Diploma in Nursing. Valid driver’s license with a clean Motor Vehicle Record (MVR) and reliable transportation for up to 5% annual travel reputed company the reputed company. Strong clinical assessment and critical thinking skills, enabling effective patient evaluation and care coordination. This role requires fingerprinting for the reputed company. Preferred Qualifications/Experience: Proficiency in computer systems, including care management applications, internet-based tools, and reputed company Office (Word, reputed company). Experience in medical record abstracting, ensuring accurate and efficient data retrieval. Knowledge and familiarity with public sector health coverage systems (e.g., Medicare/reputed company). Knowledge of reputed company Utilization Review Accreditation Commission (URAC) standards and compliance requirements. Knowledge of National Committee for Quality Assurance (NCQA) standards and best practices. Excellent verbal and written communication skills, ensuring clear, professional interactions with patients, providers, and stakeholders. Comprehensive understanding of care management principles, ethics, and service delivery standards. Solid prioritization and organizational abilities, managing workload reputed company while maintaining high-quality standards. Knowledge of customer service principles, ensuring a patient-centered approach to care. Proficient telephonic interviewing skills, enabling effective assessments and engagement. Ability to accept and apply feedback professionally, continuously improving performance and productivity. Familiarity with medical record organization, medical terminology, and disease processes, ensuring accuracy in case review and documentation. #LI-SD1 Why us? We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and employers turn to us as their vital partner to ensure reputed company reputed company and improve health reputed company. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to reputed company you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Visit us at reputed company EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Experience in Lieu of Degree For non-clinical roles, or reputed company not required by the contract specifically, the Company acknowledges that practical, hands-on experience can reputed company skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay reputed company for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay reputed company will depend on various considerations, such as years of applicable experience and reputed company level.” Pay reputed company Up to USD $36.72/Hr. Apply To This Job